MODULE 1: METHODOLOGY AND TOOLS DEVELOPMENT FOR ADULT EDUCATORS

What can we do to avoid swallowing difficulties?

When we swallow, we use 30 distinct muscles. It is critical to maintain these muscles active during treatment by continuing to eat and performing swallowing exercises both during and after treatment. These exercises will help people suffering from dysphagia stretch and strengthen their mouth and throat muscles.

Professionals involved in dysphagia management may select the most appropriate exercises for patients and show them how to do these exercises.

Useful tips to make swallowing exercises

Source: University Health Network (www.uhn.ca)

Exercise 1: The Effortful Swallow

To make your throat muscles stronger. If you're eating by mouth, repeat this activity after each bite of food.

Source: University Health Network (www.uhn.ca)

Exercise 2: The Masaco Technique

To make your throat muscles stronger.

Hold the tip of your tongue between your teeth or your lips. Try to swallow your spit while keeping your tongue in place.

Source: University Health Network (www.uhn.ca)

Exercise 3: Range of Motion Exercise (Jaw)

To stretch the muscles in your jaw.

Make your mouth as big as possible. Hold the position for 5 seconds. Make a right-hand movement with your jaw. Hold the position for 5 seconds. Make a left-hand movement with your jaw. Hold the position for 5 seconds.

Source: University Health Network (www.uhn.ca)

Exercise 4: Range of Motion Exercise (Tongue)

To stretch the muscles in your tongue.

Extend your tongue as far as it will go. Hold the position for 5 seconds. Raise your tongue to the bridge of your nose. Hold the position for 5 seconds. Make a downward motion with your tongue towards your chin. Hold the position for 5 seconds. Make a left-hand movement with your tongue. Hold the position for 5 seconds. Make a right-hand movement with your tongue. Hold the position for 5 seconds.

Source: University Health Network (www.uhn.ca)

Exercise 5: The Supraglottic Swallow

To keep your air clear.

Source: University Health Network (www.uhn.ca)

Exercise 6: Modified Shakers Exercise

1. Sit up straight and breathe deeply.

2. Place your thumbs beneath your chin.

3. Tuck your chin between your thumbs.

4. Keep your hands in place for one minute. Repeat this process three times more.

5. Hold for one second, then repeat 30 times.

Note: You should be able to feel the front of your neck exercising. There should be no discomfort in the back of your neck. REMEMBER NOT TO PUSH YOUR HEAD FORWARD.

Source: Swallowing Exercises for head and neck radiation therapy. Singapore General Hospital (https://www.sgh.com.sg/)

Tongue Base Strengthening Exercises

The base of your tongue is important for creating pressure that helps in swallowing. These workouts will strengthen and improve your tongue base's movement. Some persons who have difficulty swallowing may benefit from these exercises.

You should avoid doing these exercises with food in your mouth.

• Gauze Exercise: Between your front teeth, place a rolled piece of gauze. Hold the gauze in place gently and swallow.

• Gargle Exercise: Pull your tongue back as far as you can in your mouth. Pretend to gargle vigorously, then exhale.

• Tongue Pull-Back: Pull your tongue back into your mouth as far as possible by sticking it straight out. Hold the position for 2 seconds.

• Yawn: For 1 second, yawn and open your mouth as wide as you can.

Tongue Exercises

• Open-Mouth Swallows: While keeping your lips open, take a deep breath and swallow quickly.

• Tongue Protrusion: Stick your tongue as far as possible out of your mouth without touching your lips. Keep it there for 3-5 seconds.

• Tongue Retraction: As though you're ready to create a "kuh" sound, pull the base of your tongue back down your neck until it contacts the throat wall. Hold the position for 3-5 seconds.

• Tongue Retraction/Protrusion: Combine the two previous exercises. Hold each for a couple of seconds.

• Gargle: Make a gargle sound by pulling your tongue back into your throat. Hold for a couple of seconds.

• Tongue Lateralization: Make your tongue protrude out by pressing it hard on the inside of your cheek. For 3-5 seconds, press your index finger against your tongue through your cheek. Rep on the opposite side. 

• Tongue Press: For 3-5 seconds, press your tongue against the roof of your mouth as hard as you can.

• Tongue Sweep: Place the tip of your tongue behind your upper teeth. Return your tongue tip to the roof of your mouth slowly but firmly.

• Tongue Circles: Your tongue should be firmly pressed on the inside of your lips. Slowly make a circle to the right, then to the left.

• Teeth Counting: Slowly touch and count each of your teeth with the tip of your tongue.

Throat Exercises

• Pitch Glides: Sing “ee” starting at the lowest note and slowly slide up the scale to your highest note. Hold for 10-20 seconds.

• Shaker (Part 1): Lie on your back without a pillow. Lift your head up and look at your toes. Hold for 30 seconds, then rest for 30 seconds. Repeat 3 times.

• Shaker (Part 2): Lie on your back without a pillow. Lift your head up and look at your toes. Quickly relax your head. Repeat 30 times.

• Valsalva: Say “hut” firmly, then swallow right after.

• Towel Tuck: Place a rolled hand towel between your neck and chest. Tuck your chin and hold the towel in place without using your hands. Swallow hard.